Effect of rifampicin-based antitubercular therapy on nevirapine plasma concentrations in South African adults with HIV-associated tuberculosis

Master Thesis


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University of Cape Town

Sub-Saharan Africa is overwhelmed by dual epidemics of human immunodeficiency virus (HIV) and tuberculosis (TB) infection. Non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) is recommended for first-line treatment in adult HIV treatment programmes in resource-limited settings [1]. Many South African HIV-infected patients initiate ART while on TB treatment, 38 percent in one local study [2]. In addition, although ART reduces the incidence of TB, incidence in patients on ART is higher than in the HIV uninfected population [3], therefore incident TB on ART requiring concomitant treatment is very common. Efavirenz is regarded as the NNRTI of choice for TB co-infected patients [1] as outcomes are superior compared to those achieved with nevirapine-based ART [4] and concomitant TB treatment does not significantly reduce efavirenz concentrations [5]. However nevirapine is cheaper than efavirenz and is used extensively used in lower income countries with limited access to efavirenz [1]. Data characterising the extent to which concomitant rifampicin-based TB treatment decreases nevirapine plasma concentration therefore remain important.

Includes bibliographical references.